Appendicitis Clinical Pathway — Emergency Department

Probability of Appendicitis

High Probability	Symptoms < 48 hours Migration of pain from periumbilical to RLQ Progressive symptoms Anorexia, nausea, vomiting Pain preceding vomiting Pain with movement Cough, car ride, jumping on right foot RLQ tenderness with or without rebound
Equivocal	Focal abdominal tenderness (usually right-sided) Some of the features of High Probability acute appendicitis present
Low Probability	Few signs for appendicitis Reassess for alternative diagnosis

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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